Provider Demographics
NPI:1639601354
Name:CRISOSTOMO, ARMINDA BERONGOY
Entity Type:Individual
Prefix:
First Name:ARMINDA
Middle Name:BERONGOY
Last Name:CRISOSTOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARMINDA
Other - Middle Name:ADRIANO
Other - Last Name:BERONGOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8505 ELMHURST AVE
Mailing Address - Street 2:APT. 5C
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3357
Mailing Address - Country:US
Mailing Address - Phone:646-431-7054
Mailing Address - Fax:
Practice Address - Street 1:8505 ELMHURST AVE
Practice Address - Street 2:APT. 5C
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3357
Practice Address - Country:US
Practice Address - Phone:646-431-7054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist